anxiety

monoamines

DA, SE, NE, histamine

excitatory amino acid neurotransmitter

glutamate

inhibitory amino acid neurotransmitter

GABA

main cholinergic neurotransmitter

ACh

mild anxiety

eye contact, increased senses & to perceive reality, fidgeting, motivated, increased problem solving/learning/concentration

moderate anxiety

tense, sweating, irritable, edge, concentration, difficulties, problem solving can still occur

severe anxiety

pacing, poor eye contact, rigid, impending doom, defensive, cannot complete tasks, learning & problem solving do not occur

panic anxiety

frozen, overwhelmed, delusions, disorganized, psychotic

separation anxiety disorder

• excessive levels of concern over being away from someone/something they have an emotional attachment to

• fear of something tragic happening

• clingy & lack self direction

panic disorder

• emotional discomfort, palpitations, sweating, shaking, SOB, choking, chest pain, nausea, dizzy, chills, tingly, derealization/depersonalization, fear of losing control/dying

• usually lasts 15-30 mins

social anxiety disorder

• severe anxiety or fear provoked by exposure to a social situation in which the individual might be embarrassed

agoraphobia

• excessive anxiety or fear about being in places or situations from which escaping might be difficult or embarrassing

• usually chronic & persistent

generalized anxiety disorder

• excessive worry that lasts for at least 6 months

• restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances

OCD & related disorders

• main symptoms is presence of either an obsession, compulsion, or both

• obsession: recurring persistent thoughts/ideas/images/impulses that are intrusive & unwanted

• compulsion: repetitive behaviors/mental acts driven to perform to reduce anxiety

body dysmorphic disorder

• preoccupation w/ perceived flaws in physical appearance

• individual feels ugly, unattractive, abnormal, or deformed

hoarding disorder

• difficulties in parting w/ possessions, main motivation is related to perceived value of items or strong sentimental attachment

• social/occupational impairment, unsafe living

trichotillomania

• recurrent pulling of hair that results in hair loss

• preceded by increases tension which is then released by the action

benzodiazepines

• work on GABA

• can cause drowsiness, fatigue, respiratory depression

• potential for abuse (use only for short term)

• do not stop abruptly

• reversal drug is flumazenil

• alcohol increases effects, caffeine decreases effects

• OTC drugs, kava, valerian might enhance action, cause additive effect

• avoid alcohol & CNS depressants

SSRIs

• first line long-term treatment

• takes around 4 weeks to start working

• GI side effects, CNS side effects (nausea, diarrhea, HA, dizziness, tremors)

• sexual side effects

• avoid use in bipolar patients

• possible serotonin syndrome

benzodiazepines examples

diazepam, clonazepam, alprazolam, lorazepam

SSRIs examples

sertraline, fluoxetine, paroxetine, citalopram, escitalopram

SNRIs

• can cause weight loss

• used for MDD, anxiety, & panic

• do not stop abruptly

• possible HA, nausea, agitation, hyponatremia, HTN, & sexual dysfunction

• MAOIs/St Johns Wort —> serotonin syndrome

• NSAIDs/anticoagulants —> risk of bleeding

SNRIs examples

venlafaxine, duloxetine, desvenlafaxine

buspirone

• lower dependency than benzos

• used for anxiety; non sedating

• full effect at 4-6 weeks

• short half life, has to be taken more frequently

• possible dizziness, nausea, HA, agitation

• grapefruit juice increases drug levels

adjustment disorder

• stressor/event triggers a reaction that impacts mood/function of normal activities

• less severe than ASD/PTSD

• common reaction to stressful events causing out of proportion anxiety

ASD symptoms

symptoms present 3 days - 1 month

PTSD symptoms

symptoms are present 1 month+

ASD & PTSD

• detachment

• re-experiencing the event

• event had emotional effects

• avoidance

• month in duration

• sympathetic hyperactivity or hypervigilance

tricyclic antidepressants

• 10-14 days to start working

• maximum effect at 4-8 weeks

• possible orthostatic hypotension, anticholinergic effects, sedation, toxicity

• toxicity can cause cardiac toxicity, dysrhythmia, seizures, coma

tricyclic antidepressants examples

amitriptyline, desipramine, doxepin, imipramine

somatic symptom disorder

• expression of psychological stress through physical manifestations, can’t explain through underlying pathology

• worry about physical manifestations

illness anxiety disorder

• misinterpretation of physical symptoms/manifestations as evidence of serious disease

• preoccupation of bodily sensations

• health-seeking type —> frequently seeks medical care

• care-avoidant type —> avoids all providers

conversion disorder/ functional neurological symptom disorder

• deficits in motor/sensory function such as blindness, paralysis, seizures, or gait disorders

• converts emotional/psychological stressors into physical manifestations

factitious disorder

• AKA Munchausen syndrome

• falsifies illness or purposely gets sick by self-injury (not motivated by personal gain)